This project seeks to use a revolutionary advance in technology, Mixed Reality (MR), to create an innovative, highly involving and effective peer group resistance skill building game that delays initiation of intercourse in middle school Latinas. Latinas are part of one of the fastest growing minority groups in the US and currently have a pregnancy rate that is nearly double that of non-Hispanic whites. The middle school years are targeted because this is an ideal point at which to intervene to delay initiation of intercourse. A delay in initiation until after middle school could have considerable cost savings given the positive association between age at first intercourse and use of contraceptives, and the costs associated with early adolescent pregnancy (e.g., increased risk for pre-term birth: $190,467 per pre-term birth in 2005 US dollars). Peer group resistance skill building is also a uniquely appropriate intervention for the middle school age from a developmental standpoint: Peer influence is an important predictor of initiation of intercourse and typically peaks at age 14. This "shovel ready," two year project is guided by an interdisciplinary team working in collaboration with an afterschool and summer camp program for low income, middle school children in a predominately Latino community in Orlando, Florida. Game design is driven by a theoretical framework integrating social cognitive theory, the communication competence model, and Piaget's theory of cognitive development. The project has two phases: Phase 1 (Game Prototyping &Production, Year 1) uses 4 focus groups and consultation with 8 key informants to accomplish two specific aims: (1) Identify real-life incidents involving pressure to engage in sexual intercourse;effective resistance responses that preserve peer relationships;and patterns of verbal and non-verbal communication occurring during these real life incidents;(2) Pinpoint aspects of game play and the visual and auditory characteristics of avatars that have the greatest appeal for our targeted study population. Phase 2 (Game Prototype Testing, Year 2) assesses (1) feasibility and value of adding a peer group resistance skill building game (SBG) to a standard sex education curriculum, (2) game appeal, and (3) lessons learned for future gaming research. Feasibility and value are assessed with a randomized control trial, pilot study (n=30) in which data are (a) collected at baseline, post-test, and 1, 3, and 6 months post intervention;and (b) analyzed with Linear Mixed Modeling (continuous dependent variables) and a logistic regression approach to repeated measures (dichotomous dependent variables). Appeal is assessed by (a) tracking children's game use after all pilot data are collected, and (b) surveying adults attending a game demonstration and presentation of preliminary pilot study findings. Lessons learned are assessed by conducting a focus group with research team, afterschool staff, and key game development personnel. Project findings will be used to refine prototype, justify development of additional game scenarios for teaching peer resistance, support a larger RCT of the game's effects in Latinas, and justify developing peer group resistance SBGs for boys and other ethnic groups. PUBLIC HEALTH RELEVANCE: The teen pregnancy rate is particularly high among U.S. Latinas. This study will test a prototype for a game that builds the skills that Latinas need to resist pressure to engage in intercourse when they are in middle school, thereby decreasing their risk for teen pregnancy and sexually transmitted infections. Study results will also be helpful to other researchers developing technology based health games designed to promote health.